title: Increasing rate of TAMs and etravirine resistance in HIV-1-infected adults between 12 and 24 months of treatment: the VOLTART cohort study in Côte d'Ivoire, West Africa.
abstract: BACKGROUND
  In sub-Saharan Africa, most HIV-infected patients receive antiretroviral therapy (ART) without virological monitoring. Longitudinal data on secondary resistance are rare.
  
  
  METHODS
  We conducted a prospective cohort study of HIV-1-infected adults initiating ART in 3 clinics using computerized monitoring systems. Patients had plasma HIV-1 RNA viral load (VL) tests at months 12 (M12) and 24 (M24) after ART initiation and HIV-1 resistance genotype tests if VL was detectable (≥300 copies/mL).
  
  
  RESULTS
  Overall, 1573 patients initiated ART with stavudine/zidovudine plus lamivudine plus nevirapine/efavirenz. At M12 and M24, 944 and 844 patients, respectively, remained in active follow-up. Among them, 25% (M12) and 27% (M24) had detectable VLs and 12% (M12) and 19% (M24) had virus resistant to at least 1 antiretroviral drug, accounting for 54% (M12) and 75% (M24) of patients with detectable VLs. Among the resistant strains, 95% (M12) and 97% (M24) were resistant to lamivudine/emtricitabine, efavirenz, and/or nevirapine, the frequency of thymidine analog mutations increased from 8.1% (M12) to 14.7% (M24) and etravirine resistance increased from 13.5% (M12) to 24.5% (M24).
  
  
  CONCLUSIONS
  Of the patients with detectable VLs at M24, 25% still did not harbor resistant virus. Preventing mutations from emerging with adherence reinforcement in patients with detectable VLs remains important beyond M24. Switching therapy early in patients with resistance to 3 TC/FTC and/or to nonnucleoside reverse transcriptase inhibitors to prevent extended resistance to nucleoside reverse transcriptase inhibitors and etravirine resistance from occurring is also a major challenge.
authors.affiliation: *Programme PAC-CI/ANRS, Abidjan, Côte d'Ivoire; †INSERM, Centre 897, France; ‡University of Bordeaux, ISPED, France; §Laboratoire de Virologie, Université Paris Descartes, Sorbonne Paris Cité, AP-HP, CHU Necker-Enfants Malades, Paris; ‖CeDReS, CHU de Treichville, Abidjan, Côte d'Ivoire; and ¶Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Côte d'Ivoire.
authors.forename: Eugène
authors.initials: E
authors.lastname: Messou
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Chaix
authors.forename: Delphine
authors.initials: D
authors.lastname: Gabillard
authors.forename: Vincent
authors.initials: V
authors.lastname: Yapo
authors.forename: Thomas-d'Aquin
authors.initials: TD
authors.lastname: Toni
authors.forename: Albert
authors.initials: A
authors.lastname: Minga
authors.forename: Martial Guillaume
authors.initials: MG
authors.lastname: Kouakou
authors.forename: Eric
authors.initials: E
authors.lastname: Ouattara
authors.forename: Christine
authors.initials: C
authors.lastname: Rouzioux
authors.forename: Christine
authors.initials: C
authors.lastname: Danel
authors.forename: Serge P
authors.initials: SP
authors.lastname: Eholie
authors.forename: Xavier
authors.initials: X
authors.lastname: Anglaret
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D015331:Cohort Studies; D007560:Cote d'Ivoire; D016903:Drug Monitoring / Q000379:methods; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D008297:Male; D009154:Mutation; D009570:Nitriles; D011446:Prospective Studies; D011724:Pyridazines / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D011743:Pyrimidines; D012367:RNA, Viral / Q000097:blood; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D013936:Thymidine / Q000031:analogs & derivatives* / Q000494:pharmacology; D013997:Time Factors; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D009570:Nitriles; D011724:Pyridazines; D011743:Pyrimidines; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors; C451734:etravirine; D013936:Thymidine